HCPCS Code J7318: Hyaluronan or Derivative, Durolane, for Intra-articular Injection, 1 mg

Learn about the HCPCS code J7318 for "Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg" through this guide.

Use Code

## **What is the HCPCS code J7318 for?** The HCPCS code J7318 is part of a giant cluster of codes known as J codes. These codes are meant to designate the provision/administration of medication. For J7318, what is being designated is the administration of a 1 mg dose of hyaluronan or derivative, Durolane. It is injected intra-articularly. This injection is sometimes referred to as a Durolane injection. What is being injected is an intra-articular hyaluronic acid. It is usually injected into the knee, and its purpose is to supplement a joint's natural fluid. This leads to better lubrication of the joint, which improves joint functional capacity and mobility. It also provides better shock absorption/cushioning, which reduces knee pain and discomfort. A Durolane injection is only provided when conservative treatments have been exhausted (e.g., taking simple analgesics, getting exercise, and undergoing physical therapy) and patients don't respond adequately to those. Intra-articular hyaluronan injections can be provided to patients with osteoarthritis of the knee (e.g., unilateral secondary osteoarthritis, bilateral secondary osteoarthritis, post-traumatic osteoarthritis, etc.). Before considering intraarticular knee injections, please consider resorting to alternatives to this injection, which include intra-articular steroids for the knee joint, conservative nonpharmacologic therapy, oral pain relievers, pharmacologic therapies, physical therapy

## **Documentation requirements for J7318** As with any HCPCS code, it's important to have sufficient documentation before you decide to file for a claim for J7318. Here are examples of what you need: - The full name of the patient - The full names and credentials of the healthcare professionals who handled the patient - Relevant information from a medical record concerning the patient's condition, especially a diagnosis of knee osteoarthritis to justify medical necessity - Injection details (dosage, site of administration, and date) - Progress notes that documented the patient's persistent pain and functional limitation - Documentation of informed consent and patient response to the injection - Provider's order of the injection - If this is given as part of repeat treatment cycles/subsequent courses, there must be documentation of symptom reduction - Results of osteoarthritis-related assessments (e.g., Western Ontario and McMaster Universities Osteoarthritis Index)

## **Billing requirements for J7318** Besides the documentation requirements above, please make sure to take note of or have the following: - 1 unit is equal to 1 mg - Please use the appropriate ICD code related to the patient's condition - Use CPT code 20610 or 20611 since it's an intra-articular injection - Include the National Drug Code of the injection - Coverage may be limited to one knee per course of treatment, so please check payer-specific policies - Prior authorization - Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication. Please make sure you are familiar with the necessary coding guidelines and policy articles related to your provider (e.g., CMS/Medicaid services). This is so you can ensure that you're following correct coding practices and avoid claim rejections for this specific code.

## **Other similar codes** Here are other similar codes you can use: - **J7320** - Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg' - **J7321** - Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose - **J7322** - Hyaluronan or derivative, hymovis, for intra-articular injection, 1 mg - **J7323** - Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose - **J7324** - Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose

Frequently asked questions

It can take up to 20 minutes. The benefits don't become apparent until after a few days or weeks.

They need to avoid prolonged standing and strenuous activities for at least 2 days.

As with any injection, there will be pain in the injection site, and possibly swelling or bruising. Rare but serious complications include knee joint stiffness and weakness, infections in the injection site, and allergic reactions.